Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-20-42873 | NE |
N | 106S00000X | Behavior Technician | RBT-18-69310 | FL |
NPI | 1003477308 |
---|---|
Provider Name | Anna Maria Reick |
First Address | Omaha, NE 68137-1111 |
Second Address | Omaha, NE 68137-1111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2019 |
Last Update Date | 29/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100647500 | (05) | FL |